Todd first described it amongst children in ; the toxins were secreted by Staphylococcus aureus. Subsequently it was found to be associated with tampon use in menstruating women and Group A streptococcal infections - the streptococcal toxic shock-like syndrome STSS. It is now recognised as a consequence of a range of infections associated with toxin-secreting staphylococci and streptococci. Enhanced surveillance of the rate of Group A infections is undertaken by microbiologists in the UK and several European countries.
Received Oct 21; Accepted Jan 8. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract The authors report a case of near-fatal sepsis with multiorgan failure resulting from a Staphylococcal tampon-associated toxic shock syndrome, requiring a lengthy critical care admission.
Successful treatment of this condition focuses on early identification, source control, and administration of antimicrobial agents.
Intravenous immunoglobulin therapy used early may prevent widespread tissue necrosis. Case Report A year-old Caucasian schoolgirl presented to the Emergency Department ED complaining of a single day history of lower abdominal pain, muscle aches, diarrhoea, and vomiting.
She had a tampon in situ for 24 hours for menstrual bleeding.
She had been undergoing treatment for thyroid nodular disease using carbimazole 10 mg twice daily, which she had ceased 3 days previously. On initial examination, the patient was hypotensive systolic blood pressure 75 mmHgpyrexic temperature There were signs of multiorgan dysfunction as her skin peripheries were profoundly vasoconstricted and mottled with a significant delay in capillary refill time 10 seconds and an elevated serum lactate The patient was acutely confused and intermittently drowsy.
There was a generalized lower abdominal tenderness. Vaginal examination revealed a malodorous tampon, coated in a green mucopurulent discharge, which was removed.
The patient was sedated, intubated, and ventilated in the ED. Vasopressor support, aggressive fluid resuscitation in addition to broad-spectrum, empirical antibiotics vancomycin, flucloxacillin, piptazobactam, and clindamycin for sepsis of unknown origin and intravenous immunoglobulin treatment, was commenced.
Initial investigations showed a white cell count of High vaginal swabs returned a heavy growth of methicillin-susceptible Staphylococcal aureus. Toxin gene analysis subsequently confirmed the presence of the superantigen exotoxin, toxic shock syndrome toxin-1 TSST In the intensive care unit, her management was complicated by an acute kidney injury requiring renal replacement therapy, a sepsis-associated coagulopathy, septic encephalopathy, transient cardiomyopathy, and thyrotoxicosis.
Adult respiratory distress syndrome and a Pseudomonas aeruginosa pneumonia further complicated this patient's recovery. Following two failed extubation attempts and difficulty to wean from ventilatory support, a tracheostomy was sited.
This patient was eventually decannulated and discharged to the paediatric ward following a 1-month critical care admission. Discussion Toxic shock syndrome TSS is an acute, multisystem, toxin-mediated condition often preceded by a prodromal influenza-like illness, leading to rapid-onset shock, erythroderma, and accelerated multiorgan failure.
Staphylococcal TSS was first described among a cohort of young women inthe USA in the s and was associated with the use of super-absorbent tampon material [ 1 ].Toxic shock syndrome (TSS) is an acute, toxin-mediated illness characterized by fever, hypotension, multi-organ dysfunction, and a diffuse rash with desquamation.
The disease can be rapidly lethal and is usually treatable, though physicians often fail to recognize this condition.
Toxic shock syndrome (TSS) is an acute, multisystem, toxin-mediated condition often preceded by a prodromal influenza-like illness, leading to rapid-onset shock, . Toxic shock syndrome is a rare but serious medical condition caused by a bacterial infection. It is caused when the bacterium Staphylococcus aureus gets into the bloodstream and produces toxins.
Streptococcal toxic shock syndrome (STSS) is one of the deadliest forms of GAS infection, primarily because of delayed diagnosis and a lack of highly effective therapeutic interventions, with a . Toxic Shock Syndrome is a rare multisystem disease with many widespread symptoms.
It is caused by a toxin that is produced and secreted by the bacterium Staphylococcus aureus. The symptoms of Toxic Shock Syndrome may include a sudden high fever, nausea, vomiting, diarrhea, abnormally low blood pressure (hypotension), and a characteristic skin rash that resemble a bad sunburn.
Toxic shock syndrome (TSS) is a multisystem inflammatory response to the presence of bacterial exotoxins. Todd first described it amongst children in ; the toxins were secreted by .